Transcript American Board of Pediatrics
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The American Board of Pediatrics
The Role of Maintenance of Certification In Maintaining and Promoting Physician Competency Closing the Quality Gap
Paul V. Miles MD Vice President, Director of Quality Improvement And Assessment Performance in Practice American Board of Pediatrics
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The American Board of Pediatrics
What our patients see
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54% of the time adults receive recommended appropriate care (McGlynn) 42% of the time children receive recommended appropriate care (Mangione-Smith) “With that much variation, they can’t all be right” …..Jack Wennberg There is a gap between knowing and doing (“every system……….”)
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PMCP-G PMCP-S
Part One: Professional Standing Part Two: Lifelong Learning Part Three: Cognitive Expertise Part Four: Performance in Practice
Maintenance Of Certification Competencies
Professionalism Medical knowledge QI knowledge System knowledge Medical knowledge QI knowledge (PBLI) System knowledge (SBP) Patient Care Medical knowledge Communication QI (PBLI) System-based practice
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PMCP
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First cohort began in 2003 Approximately 4500 pediatricians each year By 2010 this group must meet the requirements for all four parts of MOC
The American Board of Pediatrics
PMCP-G Maintenance Of Certification PMCP-S
Assessment Tools
5 Part One: Professional Standing Valid license, no restrictions Part Two: Lifelong Learning ABP GP knowledge SA AAP PREP (ABP approved) ABP Decision Skills Assessment ABP Knowledge SA (literature review) AAP NeoReviews (ABP approved) Other Subspecialty Prep programs Part Three: Cognitive Expertise Secure, proctored exam Part Four: Performance in Practice Web-based modules and/or Established QI effort (ABP approved) Patient/Peer Survey
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Part 1
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Valid, unrestricted license – Maintenance of licensure (MOL) DANS national reporting system for physicians with restrictions to their medical license
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The American Board of Pediatrics Part 2: Knowledge Self Assessment (Open book, low stakes, requires passing score)
Existing
Year ABP Knowledge self-assessment ABP Decision Skills AAP PREP (broad based general knowledge) Subspecialty modules (current best articles) Subspecialty prep programs (eg. Neoreviews) 2006 2006 2003 2006-9 2006-10
In Development
QI Self Assessment 2008
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Part 3: Secure Cognitive Examination
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Cognitive simulation of practice Predominantly assesses higher-order intellectual abilities —not recall Clinical Judgment: >50% Synthesis: 20 to 35% Recall Knowledge: <15% Includes conditions that could present to any practice, but doesn’t require knowledge that good practitioners would normally “look up”
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Part 4
Diplomate enrolls in MOC On the ABP Web-site
Patient Survey Part 4 Practice Assessment & Improvement
Option A Option B Web based modules Participate in Established Such as eQIPP or ABMS Improvement Project Patient Safety Module (including attestation forms) Complete QI Knowledge Self Assessment (Required with Option B) Credit for Part IV MOC
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Pediatric CAHPS
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Developed for ambulatory care Provide feedback to pediatricians on how well they communicate with patients and involve them in care Built into an improvement model (physicians will be given strategies to test to improve their communication performance) Has the ability to discriminate at the individual or the group level
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Part 4
Diplomate enrolls in MOC On the ABP Web-site
Patient Survey Part 4 Practice Assessment & Improvement
Option A Option B Web based modules Participate in Established Such as eQIPP or ABMS Improvement Project Patient Safety Module (including attestation forms) Complete QI Knowledge Self Assessment (Required with Option B) Credit for Part IV MOC
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ABP Focus on Quality Improvement
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The MOC process is focused on helping pediatricians measure and improve quality of care and their professional development The ABP is not interested in trying to measure individual physician practice performance
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Looking for Bad Apples
(historic approach to physician quality) 13 Brent James Patient Safety Reporting Systems and Applications IOM
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Improving Good Apples (ABP focus)
14 Brent James Patient Safety Reporting Systems and Applications IOM
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Part 4: Self-Evaluation of Performance in Practice
Understand the benefits of collecting data from your own practice.
Collect data on a specific disease entity or problem from your patients’ charts.
After collecting data, interpret and analyze it so you can use it.
Compare your care with peers and benchmarks to be able to learn from others Based on your analysis, identify and test opportunities for improvement within your practice.
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Part 4A: Web Based QI Modules
ABP Approved Products:
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Education in Quality Improvement for Pediatric Practice (AAP eQIPP)
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Patient Safety Improvement Program (ABMS) Performance Improvement Modules (being developed with the AAP)
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Performance Improvement Modules
Diplomate Registers & Chooses Module Diplomate Measures Practice Quality Diplomate Chooses Change Package Diplomate Re Measures Quality Clinical Data Survey Data Rapid Cycle Improvement Change Package 1 Change Package 2 Change Package 3
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Part 4B: Credit for Established QI
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Recognition of valid participation in an ABP approved structured quality improvement program Boards set standards for design, implementation, and results of structured QI programs.
Boards set standards defining meaningful participation in accredited programs.
Programs apply for accreditation.
Physicians supply attestation and documentation of participation for Part 4 credit.
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Existing – 4A Web based
Part 4
eQIPP modules (Asthma & ADHD)
In Development – 4A Web based
ABMS Patient Safety Module eQIPP Nutrition & other modules Performance Improvement Modules (PIMs)
In Development – 4B
Credit for ongoing projects Year 2004 2007 2007 2007 2007
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20 Medical Knowledge Quality Improvement Knowledge Measurement Improvement Re Measurement
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QIPP allows the learner to quickly assess their practice online.
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A real-time data analysis allows the learner to begin to identify opportunities for improvement.
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QIPP offers an interactive learning environment. The program also includes practical, easy-to-use tools that can be implemented quickly into the office setting.
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After completing the clinical content, the learner uses the
Model for Improvement
to identify opportunities for improvement in their practice.
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Within each step, the learner will receive advice for identifying, prioritizing, refining, and launching new improvement cycles.
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QIPP subscribers have access to the modules for three years. You will be able to track your progress, and monitor your successes over time.
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The Challenge for Medical Education
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How do we integrate medical education with the delivery of quality care so that students see and participate in the ongoing assessment and improvement of care that is safe, timely, effective, efficient, patient centered and equitable?